Introduction to Acute Oncology

Julie Skelton/Kristen Gibson

Acute Oncology Clinical Nurse Specialists

Overview of the Acute Oncology Service

Overview of cancer therapies

Primary complications/side effects of cancer treatment

Oncological emergencies Neutropenic sepsis/Febrile Neutropenia

Malignant Spinal Cord Compression (MSCC)

Superior Vena Cava Obstruction (SVCO)

MUO/CUP

Contact details

AIMS

To provide acute care to patients who have adverse complications/side effects from: their cancer diagnosis

following SACT, Targeted therapy or Radiotherapy

To provide expert advice for patient/relatives/other health professionals

Key worker for Cancer of Unknown Primary patients

To assess, plan and implement acute nursing care in accordance with local and National guidelines

Overview of the Acute Oncology Service

To liaise with chemotherapy triage nurse and other chemotherapy professionals

To analyse and react upon haematology and biochemistry results

To act as support and information source for patients and families

To act as a link between Oncologists, ED, Medical, Surgical clinicians, GP’s, patients and their families

Oncologists based at Castle Hill Hospital

Haematologists based at York Hospital

Overview of the Acute Oncology Service

Chemotherapy

Immunotherapy

Targeted therapies

Monoclonal antibodies

Radiotherapy

Supportive therapies

Cancer therapies

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. www.cancer.gov

Tend to be better tolerated

Often given in combination with chemotherapy

Important to remember that side effects and toxicities from targeted therapies can present up to 6 months from completion of treatment

TARGETED THERAPIES (also known as biological therapies)

Rituximab..has been used for many years

Indications : NHL, CLL

Bevacizumab..Also known as Avastin

Indications : Colorectal, NSCLC, Ovarian

Trastuzumab.. Also known as Herceptin

Indications : Breast, Oesophogeal

Monoclonal antibodies

Erlotinib (tarceva) used for Non Small Cell Lung Cancer, a tyrokinase inhibitor

Sorafenib used to treat some kidney and liver malignancies

Dasatanib used for Chronic Myeloid Leukaemia

Bortezemib (Velcade) Used to treat Myeloma

Other Biological / Targeted Therapies

Epidermal growth factor (EGF) is a growth factor that stimulates cell growth, proliferation, and differentiation by binding to its receptor EGFR. Targeted therapies harness the potential of the receptor within the epiderm, hence when a patient develops a rash with treatment it is often a sign that the treatment is being effective.

Some MOABs and TKIs are targeted to the EGFR

EGFR (Epidermal Growth Factor Receptor)

Febrile Neutropenia/Neutropenic sepsis

Malignant Spinal Cord Compression (MSCC)

Superior Vena Cava Obstruction

Suspected PE/DVT

Nausea and vomiting

Diarrhoea

Constipation

Electrolyte imbalances

Hypo/Hypercalcaemia

Complications/Side effects of cancer treatment

Hypomagnesaemia

Bone marrow suppression causing pancytopenia

Mucositis

Palmar Plantar Erythema (PPE)

Rash

Pleural effusions

Ascites

Complications/Side effects of cancer treatment

Neutrophils <1

Nadir usually between 7-14 days depending on treatment regimen

Fever, but often with no other symptoms, expect rapid deterioration. Do not wait for blood results – treat!

Blood cultures must be taken; 2 sets peripherally and 1 set from any lines

Broad spectrum antibiotics within the hour;

Tazocin plus Gentamicin if severe sepsis For non-severe penicillin allergy:

Meropenum For severe penicillin allergy

Vancomycin and Aztreonam

Neutropenic Sepsis/Febrile Neutropenia

Patients advised to monitor their temperature daily whilst having chemotherapy.

For daily FBC, once neutrophils equal to or above 1

and patient is well, for discharge from hospital.

May need dose reduction or Granulocyte-Colony Stimulating Factor (G-CSF) adding to next cycle.

Neutropenic Sepsis/Febrile Neutropenia

3-5% pts with cancer 10% patients with spinal mets Compression site: 70%Thoracic 20% Lumbar/sacrum 10% Cervical

Common cancers associated with MSCC: Breast Prostate Lung Cancer of Unknown Primary Lymphoma Multiple myeloma

MSCC

Suspect it…complete a neurological examination and consider:

Is the patient known to have skeletal mets?

Worsening or new onset of spinal pain?

Nocturnal spinal pain disturbing sleep?

Gait disturbance?

Spinal pain on lying flat or on straining e.g. coughing, sneezing?

Any limb weakness/numbness/tingling sensation?

Bowel and/or bowel problems

MSCC

If suspected give stat dose of 16mg dexamethasone with PPI cover Refer to MSCC pathway:

Contact Acute Oncology CNS on 07979 645059 / 07721 444002 Request urgent MRI and obtain verbal report

If confirmed MSCC:

Patient will be referred to the neurosurgeons at HRI via referapatient.org. If accepted patient will be transferred to Ward 4 when bed available.

If not for neuro intervention; Transfer arranged to CHH, via bleep 500 and discussed with Oncology SpR on call, patient will need urgent radiotherapy.

MSCC

Most common in lung cancer patients Symptoms/signs: Breathlessness is the most common symptom (>60%) Swelling or discolouration of the face and neck Feeling of fullness in the head Bending forward or lying flat may aggravate signs and

symptoms Non-pulsatile raised jugular venous pulse [JVP] Dilated anterior chest wall and neck veins

SVCO

Investigations: Chest x-ray / CT Thorax

Treatment: Dexamethasone 16mg with PPI cover Vascular stent (not available at SGH) Chemotherapy for small cell lung cancer and

lymphoma Radiotherapy for non-small cell lung cancer

SVCO

Refer patient via 2WW

Contact Acute Oncology/CUP CNS’ to make them aware of the referral and for any advice regarding further investigations

Request urgent CT chest, abdomen and pelvis

MUO/CUP referrals

Julie Skelton – Lead Acute Oncology CNS

Tel 6236 / 07979 645059

Kristen Gibson – Acute Oncology CNS

Tel 6236 / 07721 444002

Working hours Monday – Friday 8am – 6pm

AO Contact details

Any questions?

Thank you